The effects of group work therapy in patients with Alzheimer's disease.
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Aged↗
Biomedical subjects
K Meguro
Publications and source records attributed to K Meguro.
Atrophy of the corpus callosum correlates with white matter lesions in patients with cerebral ischaemia.
Many studies of white matter high signal (WMHS) on T2-weighted MRI have disclosed that it is related to cerebral ischaemia and to brain atrophy. Atrophy of the corpus callosum (CC) has also been studied in relation to ischaemia. Our objective was to test the hypothesis that CC atrophy could be due to ischaemia. We therefore assessed CC, WMHS and brain atrophy in patients with risk factors without strokes (the risk factor group) and in those with infarcts (the infarct group), to investigate the relationships between these factors. We studied 30 patients in the infarct group, 14 in the risk factor group, and 29 normal subjects. Using axial T1-weighted MRI, cortical atrophy and ventricular enlargement (brain atrophy) were visually rated. Using axial T2-weighted MRI, WMHS was assessed in three categories: periventricular symmetrical, periventricular asymmetrical and subcortical. Using the mid-sagittal T1-weighted image, the CC was measured in its anterior, posterior, mid-anterior and mid-posterior portions. In the normal group, no correlations were noted between parameters. In the infarct group, there were significant correlations between CC and brain atrophy, and between CC atrophy and WMHS. After removing the effects of age, gender and brain atrophy, significant correlations were noted between some CC measures and subcortical WMHS. In the risk factor group, there were significant correlations between CC and brain atrophy and between CC atrophy and WMHS. After allowance for age, gender and brain atrophy, significant correlations between some CC measures and periventricular WMHS remained. The hypothesis that CC atrophy could be due to cerebral ischaemia was supported by other analyses. Namely, for correlations between the extent of infarcts and partial CC atrophy in patients with anterior middle cerebral artery (MCA) and with posterior MCA infarcts, there were significant correlations between the extent of infarct and mid-anterior CC atrophy in the former, and posterior CC atrophy in the latter. Our findings could indicate that CC atrophy is associated with cerebral ischaemia.
Adult↗
Endothelin-1 concentration increases in the cerebrospinal fluid in cerebral vasospasm caused by subarachnoid hemorrhage.
BACKGROUND: Endothelin-1 (ET-1) was originally identified as a potent vasoconstrictor peptide. Numerous reports have suggested its roles in various disorders. Although there is a great deal of evidence establishing the relationship between ET-1 and cerebral vasospasm in animals, this relationship still remains to be clarified in humans. METHODS: The concentration of ET-1 in cerebrospinal fluid (CSF) was measured by radioimmunoassay in 23 subarachnoid hemorrhage patients. CSF samples were collected every 10 days after surgery from the cisternal drainage tube. RESULTS: Initial concentrations of ET-1 in the CSF collected the first day after operation were all increased compared with the control CSF. In seven of the eight vasospasm patients, the concentrations of ET-1 had increased before the observation of vasospasm and then decreased before the disappearance of the vasospasm. In 13 out of the 15 patients without vasospasm, the concentrations of ET-1 in CSF decreased with time. CONCLUSION: We confirmed that the concentration of ET-1 in CSF increased before the onset of cerebral vasospasm caused by subarachnoid hemorrhage. The ET-1 concentration in the CSF could be a useful marker to detect cerebral vasospasm after subarachnoid hemorrhage.
Adult↗
Differentiation of mechanism and prognosis of traumatic brain stem lesions detected by magnetic resonance imaging in the acute stage.
We retrospectively evaluated the MRI from 17 patients with primary brain stem injury obtained in the acute stage. Clinical and radiological findings were analyzed in these 17 patients. T2-weighted imaging proved to be most sensitive and specific for the diagnosis of primary brain stem injury. We found two patterns of brain stem injury. The good prognosis group showed ventral brain stem lesions or dorsal superficial brain stem lesions. On the other hand the poor prognosis group showed deep dorsal brain stem lesions. These acute stage findings are seen only temporally in many cases so that it is most important to examine MRI findings in the acute stage to evaluate the prognosis of the patient. MRI was valuable in predicting the outcome. The possible mechanism of brain stem injury in patients with head injury is briefly discussed.
Acute Disease↗
Histamine H(1) receptors in patients with Alzheimer's disease assessed by positron emission tomography.
Cerebral histamine H(1) receptor binding was measured in vivo in 11 normal subjects (six young and five old) and 10 patients with Alzheimer's disease by positron emission tomography and [11C]doxepin, a radioligand for H(1) receptors. The parametric images describing the tracer kinetics were generated by either compartmental or graphical analysis, and were examined statistically on region-of-interest and voxel-by-voxel bases. The binding potential of H(1) receptors showed a significant decrease particularly in the frontal and temporal areas of the Alzheimer's disease brain compared to the old, normal subjects. In addition, the receptor binding correlated closely to the severity of Alzheimer's disease assessed by the Mini-Mental State Examination score within several brain areas. The ratio of K1 values between the brain areas and the cerebellum was used as a relative measure of regional cerebral blood flow which decreased in the frontal and temporal areas of the Alzheimer's disease brain. However, the difference in the binding potential (total concentration of receptor/equilibrium dissociation constant) between the Alzheimer's disease patients and the old, normal subjects was greater than that in the cerebral blood flow, and the rate of decrease in the binding potential with the progression of Alzheimer's disease was greater than the rate of decrease in the cerebral blood flow. This study reveals the predominant disruption of the histaminergic neurotransmission in the neurodegenerative processes of Alzheimer's disease. This study suggests that the decline of the histamine receptor binding might play a substantial role in the cognitive deficits of Alzheimer's disease patients.
Adult↗
Immediate surgery reduces mortality in deeply comatose patients with spontaneous cerebellar hemorrhage.
Cerebellar hemorrhage is regarded as a neurosurgical emergency. However, patients with deteriorating consciousness are very likely to die irrespective of the choice of therapy, and it is not clear if surgical intervention can benefit patients in a deeply comatose state. We reviewed 20 patients with a Glasgow Coma Scale score of 3 at admission to ascertain the salvage rate and determine the prognostic factors. Four patients who were managed conservatively died within 2 days. Sixteen patients underwent decompressive suboccipital craniectomy and hematoma evacuation. At discharge, three patients were moderately disabled, three were severely disabled, four were persistently vegetative, and six had died. The overall mortality was 50%. The mean interval between the onset of symptoms and the operation was 1.67 +/- 0.29 hours in patients with favorable outcome, and significantly longer at 2.42 +/- 0.49 hours in patients with an unfavorable outcome (p = 0.025). Immediate evacuation of the hematoma reduces morbidity and mortality even in deeply comatose patients, especially if the time interval between the onset and surgery is within 2 hours.
Adult↗
Intracerebellar penetrating injury and abscess due to a wooden foreign body--case report.
A 4-year-old boy presented with chopstick penetration into the cerebellum via the temporal squamosa and tentorium cerebelli, which resulted in a cerebellar abscess 1.5 years after the injury. The neuroimaging appearance of the wooden chopstick were unusual, hyperdense on computed tomography, and isointense on T2-weighted and hypointense on T2-weighted magnetic resonance imaging. Abscess aspiration and continuous drainage was performed with real-time intraoperative ultrasound guidance. The chopstick fragment was surgically removed and the patient discharged with minor neurological deficits. Wooden foreign body may show changes in properties after a long period of intraparenchymal retention. Extra care is required to remove wooden foreign bodies because of the high risk of infection.
Brain↗
[Perioperative stress response in elderly patients for elective gastrectomy--the comparison between isoflurane anesthesia and sevoflurane anesthesia both combined with epidural anesthesia].
The difference in stress responses between isoflurane anesthesia (I group) and sevoflurane anesthesia (S group) was studied. Twelve patients for elective gastrectomy were divided into two groups: S group, 7 patients, 78 +/- 4.3 years of age, and I group, 5 patients, 77.4 +/- 6.9 years of age. Anesthesia was induced by fentanyl, midazolam and sevoflurane or isoflurane with 100% oxygen. After laryngeal mask air way was inserted under spontaneous ventilation, anesthesia was maintained with air (3 l.min-1), oxygen (2 l.min-1), sevoflurane or isoflurane and epidural block. Vecuronium bromide was given during surgery when needed. The demographic data were not different between the two groups. During operation, it was confirmed that the responses of sympathetic nervous system (epinephrine, norepinephrine) and pituitary-adrenocortical system (ACTH, cortisol) were maintained in both groups. After operation plasma norepinephrine levels increased in both groups. Although the responses of I group tended to be stronger than that of S group, there was no significant difference between the two groups.
Aged↗
[Treatment of peripheral aneurysms of the posterior circulation].
Peripherally located aneurysms of the posterior circulation are extremely rare. The outcome of patients with peripherally located aneurysms has been poor, and the treatment of such aneurysms has been surgically challenging. We report a consecutive series of peripherally located ruptured aneurysms in the posterior circulation, and discuss in this article the optimal treatment strategy for such lesions. Clinical presentation, neuroradiological findings, treatment method, and the outcome were reviewed retrospectively. Two cases with distal posterior cerebral artery aneurysm, two with distal posterior inferior cerebellar artery aneurysm, two with anterior inferior cerebellar aneurysm, and one with superior cerebellar artery aneurysm were included in this study (mean age, 59.3 +/- 16.0, M:F = 1:6). Three patients with good neurological status on admission who underwent clipping of the aneurysmal neck via craniotomy showed a favorable outcome. In contrast, four patients with poor neurological status on admission who underwent endovascular proximal occlusion of the parent artery showed an unfavorable outcome. Although the outcome of patients who underwent endovascular surgery was poor, endovascular proximal occlusion was effective in preventing re-rupture of the aneurysms. Proximal occlusion of the parent artery has several shortcomings such as cerebral infarction, but proximal occlusion at the very distal area of the parent arteries would not be critical because of good collateral circulation. Thus, endovascular proximal occlusion may provide us another option in the treatment of peripherally located aneurysms especially in patients with poor neurological status. Further data is needed to discover the optimal treatment for patients with peripherally located cerebral aneurysms.
Adult↗
[Anesthetic management of the elderly patients with femoral neck fracture by sevoflurane and femoral nerve block].
Fracture of the femoral neck (FNF) is a significant cause of morbidity and mortality in the elderly, and the elderly with FNF are often high-risk patients for anesthesia. We studied 15 patients above 80 years of age with severe physical status (ASA III-IV). After femoral nerve block (for the pain of fracture) and lateral femoral cutaneous nerve block (for the cutting pain), surgical procedure was performed under general anesthesia by laryngeal mask airway under spontaneous ventilation. After the operation, morphine 2 mg was administered subcutaneously. In our experience, the majority of 15 patients cardiovascular status of remained stable, except one patient who needed ephedrine for hypotension and another patient who needed diclofenac sodium for post-operative pain relief.
Aged↗
[Perioperative care for surgical patients with respiratory tract disease--preparation of the guideline(discussion)].
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Anesthesia↗
A small-molecule, nonpeptide CCR5 antagonist with highly potent and selective anti-HIV-1 activity.
The beta-chemokine receptor CCR5 is considered to be an attractive target for inhibition of macrophage-tropic (CCR5-using or R5) HIV-1 replication because individuals having a nonfunctional receptor (a homozygous 32-bp deletion in the CCR5 coding region) are apparently normal but resistant to infection with R5 HIV-1. In this study, we found that TAK-779, a nonpeptide compound with a small molecular weight (Mr 531.13), antagonized the binding of RANTES (regulated on activation, normal T cell expressed and secreted) to CCR5-expressing Chinese hamster ovary cells and blocked CCR5-mediated Ca2+ signaling at nanomolar concentrations. The inhibition of beta-chemokine receptors by TAK-779 appeared to be specific to CCR5 because the compound antagonized CCR2b to a lesser extent but did not affect CCR1, CCR3, or CCR4. Consequently, TAK-779 displayed highly potent and selective inhibition of R5 HIV-1 replication without showing any cytotoxicity to the host cells. The compound inhibited the replication of R5 HIV-1 clinical isolates as well as a laboratory strain at a concentration of 1.6-3.7 nM in peripheral blood mononuclear cells, though it was totally inactive against T-cell line-tropic (CXCR4-using or X4) HIV-1.
Amides↗
Arterial tonometry in the measurement of the effects of innocuous mechanical stimulation of the neck on heart rate and blood pressure.
Arterial tonometry was used to continuously monitor the effects on heart rate and blood pressure of a series of innocuous mechanical stimuli applied to the neck in conscious humans. The stimuli used were derived from procedures commonly employed in clinical examination and physical therapy of the neck. In alert subjects, the stimuli used generally caused small and sometimes statistically significant decreases in heart rate, systolic pressure and diastolic pressure. In alert subjects, statistically significant decreases in systolic and diastolic pressure were particularly associated with stimuli which involved full rotation of the neck. In the course of the prolonged series of stimuli, some subjects slept or reported being on the verge of sleep. In these subjects, the same stimuli produced mixed effects on heart rate and increases in systolic and diastolic pressure which were significantly different from the effects obtained in fully alert subjects.
Adult↗
Combined use of T1-weighted MRI and MRA for stereotaxic lesioning of the nonhuman primate brain: application to the rhinal cortex.
Stereotaxic brain lesioning is widely used to develop experimental models of human brain disease in the nonhuman primate. To avoid intraoperative vascular complications such as intracranial hemorrhage, we developed a methodology that is easy to implement. This method combines T1-weighted magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). This technique is applied to produce bilateral neurotoxic lesions of the rhinal cortex, a structure located medially in the temporal lobe, in eight baboons (including five sham-operated animals with needle descents but no ibotenic acid injection). Two other baboons were lesioned before the MRA technology was available. The MRA sequence (two-dimensional time-of-flight, axial acquisition) was used to localize the blood vessels in the needle trajectories, i.e., the highly vascularized sylvian fissure and temporal gyri. The vessel coordinates were transposed onto the coronal MRI-TI images, onto which the injection sites were determined and the planned needle tracks drawn. In the eight baboons that had MRA, 26.8% of these needle tracks had to be slightly displaced because of the presence of blood vessels. The stereotaxic coordinates of the final target sites were then calculated with respect to six skull landmarks that also served as a reference during surgery. No intracranial hemorrhage occurred in any of the eight baboons in which MRA was performed, in contrast to one of the two baboons not studied with MRA. The histological analysis showed a good extent of the rhinal lesions in all lesioned animals, with minimal damage to areas other than those that were targeted. Thus, combined use of MRI-TI and MRA proved to be reliable in reducing vascular complications, affording new advances for stereotaxic surgery in nonhuman primates.
Animals↗
Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis.
A 3-month-old male infant with intracranial hemorrhage attributable to a vitamin K deficiency is reported. Vitamin K2 was administered orally at birth and then at 5 days and I month of age. Oral antibiotics were also given 2 days before the onset of bleeding. Although the incidence of intracranial hemorrhage resulting from vitamin K deficiency has decreased since the introduction of vitamin K2 prophylaxis, spontaneous intracranial hemorrhages are still being reported in infants. We suggest that vitamin K prophylaxis is needed especially for breast-fed infants and for those undergoing antibiotic therapy.
Cerebral Hemorrhage↗
Embolization of a ruptured aneurysm of the distal anterior inferior cerebellar artery: case report and review of the literature.
BACKGROUND: Aneurysms of the distal anterior inferior cerebellar artery (AICA) are rare and almost all of them have been treated surgically, by wrapping or trapping, in the previous literature. Most cases of aneurysms associated with the auditory artery resulted in a hearing disturbance from the surgical procedure, although aneurysms far from the auditory artery had no deficit from trapping. METHODS: An 81-year-old woman presented with a ruptured aneurysm of the distal AICA. We planned a delayed treatment with intravascular embolization because of her advanced age and poor clinical status. Embolization of the distal anterior inferior cerebellar artery using detachable coils remote from the auditory artery was successful. RESULTS: Magnetic resonance imaging after embolization demonstrated no remaining lesion. The patient has been through rehabilitation and has gradually improved. CONCLUSION: Intravascular treatment of distal AICA aneurysms remote from the auditory artery may be safer and simpler than surgical treatment.
Aged↗
Neocortical and hippocampal glucose hypometabolism following neurotoxic lesions of the entorhinal and perirhinal cortices in the non-human primate as shown by PET. Implications for Alzheimer's disease.
Temporoparietal glucose hypometabolism, neuronal loss in the basal forebrain cholinergic structures and preferential accumulation of neurofibrillary tangles in the rhinal cortex (i.e. in the entorhinal and perirhinal cortices) are three early characteristics of Alzheimer's disease. Based on studies of the effects of neurotoxic lesions in baboons, we previously concluded that damage to the cholinergic structures plays, at best, a marginal role in the association neocortex hypometabolism of Alzheimer's disease. In the present study, we have assessed the remote metabolic effects of bilateral neurotoxic lesions of both entorhinal and perirhinal cortices. Using coronal PET coregistered with MRI, the cerebral metabolic rate for glucose (CMR(glc)) was measured before surgery and sequentially for 2-3 months afterward (around days 30, 45 and 80). Compared with sham-operated baboons, the lesioned animals showed a significant and long-lasting CMR(glc) decline in a small set of brain regions, especially in the inferior parietal, posterior temporal, posterior cingulate and associative occipital cortices, as well as in the posterior hippocampal region, all of which also exhibit glucose hypometabolism in Alzheimer's disease. Remarkably, the degree of CMR(glc) decline in four of these regions significantly correlated with the severity of histologically determined damage in the rhinal cortex, strongly supporting the specificity of the observed metabolic effects. There were also differences between the metabolic pattern observed in the lesioned animals and that classically reported in Alzheimer's disease; for instance, the hypometabolism we found in the stratum has not been reported in early Alzheimer's disease, although this structure can be affected in late stages of the disease and has direct anatomical connections with the rhinal cortex. Nevertheless, this study shows for the first time that the temporoparietal and hippocampal hypometabolism found in Alzheimer's disease may partly result from neuroanatomical disconnection with the rhinal cortex. This, in turn, further strengthens the hypothesis that neuronal damage and dysfunction in the rhinal cortices play a major role in the expression of Alzheimer's disease.
Alzheimer Disease↗
Assessment of renal effects of sevoflurane in elderly patients using urinary markers.
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Aged↗